LAUSR

A major disruption has occurred in the world of diagnostic imaging with the advent of ultrasound contrast. Ultrasound contrast will change the diagnostic algorithms used to evaluate many of the mass lesions that we currently characterize using common tools such as computed tomography (CT) and magnetic resonance (MR). In particular, it shows a tremendous added value for evaluating hepatic and renal neoplasms. It can be used in patientswith renal failure diabetes and hypertension, and the incidence of allergic reactions and complications is vanishingly low even in comparison with the low rates of reactions for iodineand gadolinium-based contrast agents. Because ultrasound is less expensive than CT andMR, one would expect decreased cost to be associated with this use. An underrepresented savings, however, is the decreased amount of time necessary to arrive at a final diagnosis in comparison with CT and MR. This requires a dedicated commitment toward using contrast on the fly one on clinical service. Those of us in the Society of Radiologists in Ultrasound are committed to this, and I think we recognize more than anyone that a failure to move in this direction, changing our algorithms to include ultrasound contrast rather thanmultiphase CT andMR and ultimately do the right thing by our patients, is essential if we are going to hold onto this technique. With point-of-care ultrasound and more clinicians than ever doing ultrasound for themselves, it is entirely conceivable that if we do not provide contrast ultrasound service, they could in the future do this for themselves. In which case, they would perform the examination and then not order a CT orMR, and radiology would then take a double hit for not doing either examination. At this time, appropriateness criteria and white papers including ultrasound contrast have not been written and published, but they are coming and all of us welcome their presence as the world of diagnostic imaging is disrupted by the development of ultrasound contrast. That said, the lead article in this issue ofUltrasound Quarterly is a cost analysis written by Dr EdGrant from the University of Southern California. Although this is a small single-institution study, it is a harbinger of what we all think the future will be, and it sets up the basis for further research and development in this area. The next article describes an ancillary technique for the use of ultrasound contrast bubbles, and this is the delivery of chemotherapeutic agents to tumors. A series of musculoskeletal ultrasound imaging articles include imaging of the brachial plexus, ultrasound detection of rat sciatic nerves, perineural hydrous dissection of the sciatic nerve, optimizing the time for developmental dysplasia hip screening in neonates, and improving positioning techniques in the ultrasound evaluation of the elbow. Next, there are several vascular articles including assessment of subclinical atherosclerosis and vitamin D deficiency and shear wave elastography in the evaluation of liver fibrosis, followed by the measurement of spleen stiffness for predicting splenomegaly etiology. Lung ultrasound continues to gainwidespread acceptance in specialties outside radiology, but some articles are beginning to be submitted to ultrasound or radiology journals. We feature 2, the first involving the diagnosis of pneumonia in childrenwith lung ultrasound and the second involving shear wave elastography in the characterization of pleural effusions. Both are important novel applications of ultrasound in the diagnosis of pulmonary disease, and again, if we as radiologists do not perform the services, the clinicians will do it instead and call it point-of-care ultrasound. This issue concludes with several abdominal ultrasound articles including ultrasound assessment of acute kidney injury, detection of portal venous gas in pediatric patients, hyperechoic abdominal fat as a sentinel sign of inflammation, and multimodality imaging of congenital variants of the gallbladder. As always I am very grateful to the editorial board, reviewers, and publishers of Ultrasound Quarterlywho bring the information presented in all of these issues from all around the world to all of us in radiology who perform ultrasound all over the world.